Antibiotics Send 70,000 Kids to the ER

Before the beginning of the 20th century, the average life expectancy was 47 years, even in the industrialized world.1 Infectious diseases such as pneumonia, syphilis and smallpox were rampant. The discovery of penicillin in 1928 marked the beginning of a revolution against microbes that had assailed human health for centuries.

Discoveries of many new classes of antibiotics occurred during the antibiotic era. In the U.S., the leading cause of death became noncommunicable diseases, such as cardiovascular disease, cancer and stroke, as compared to communicable diseases, and the average life expectancy rose to 78.8 years.2 But overuse has led to a reduction in effectiveness.

The drugs that transformed life in the early 1900s now saturate concentrated animal feeding operations (CAFOs), and are offered to many who seek medical care with anything appearing like an infection. Antibiotics are also sprayed on crops,3 dumped in rivers with treated and untreated waste4 and painted on the hulls of boats5 to keep off barnacles.

Over the decades these tiny microbes have begun to evade the drugs used to kill them, developing into antibiotic-resistant pathogens estimated to cause at least 2 million infections annually, leading to 23,000 deaths each year in the U.S. alone.6According to the World Health Organization:7

"The world is heading toward a post-antibiotic era, in which common infections and minor injuries, which has been treatable for decades, can once again kill."

Before antibiotics, alternative therapies were used to treat infections, although none was as reliably effective as antibiotics for severe infections. While critical for certain conditions, overuse has increased the risk of other diseases and contributed to the rising number of antibiotic-resistant pathogens.

Antibiotic Reactions Affect Tens of Thousands of American Children

Antibiotics transformed health care, but as with any foreign substance, they carry risks. When absolutely necessary, the benefits usually outweigh the risk. However, when they are used unnecessarily, the patient is often exposed to preventable and potentially serious health conditions.

Unfortunately, recent data show tens of thousands of children who take antibiotics end up in the emergency room as a result of immediate adverse reactions related to the drugs, to the tune of about 70,000 children each year.8

Although these numbers sound high, pediatric infectious disease specialist Dr. Michael Russo believes this is only the tip of the iceberg,9 since the study only included children who went to the ER and not those treated in an urgent care, doctors' office or at home.

According to data from the Centers for Disease Control and Prevention (CDC),10 269 million prescriptions for antibiotics were written in 2015. The math reveals that for every 1,000 people, adults and children, there were 838 prescriptions written for antibiotics.

Data were compiled using nationwide estimates for outpatient prescriptions and a nationally representative sample of hospitals for emergency rooms visits for children younger than 19.11 The scientists found 86 percent of the children who were treated experienced an allergic reaction, including rash, angioedema (severe swelling beneath the skin) and pruritus (itching).

After analysis, researchers determined children aged 2 and younger had the highest risk of adverse drug events, and 41 percent of visits involved children in this age group.12 Amoxicillin was the most commonly prescribed antibiotic implicated in children age 9 or younger, while trimethoprim and sulfamethoxazole more commonly triggered reactions in children ages 10 to 19.

Data did not determine which prescriptions were unnecessary or inappropriate for the patient's condition as that information was unavailable. However, the researchers note in their press release:13

"Antibiotics are among the most commonly prescribed medications for children, but prior research has suggested that nearly a third, if not more, of outpatient pediatric prescriptions for antibiotics are unnecessary."

Adverse Events From Antibiotics Affect Adults Too

Antibiotic prescriptions in outpatient settings actually declined by 5 percent between 2011 and 2014.14 However, when antibiotics are needed, the CDC found prescribers often favored potentially less effective drugs. They also found inappropriate use — including unnecessary use and inappropriate selection — dosing and duration, may actually approach 50 percent of all outpatient prescriptions.15

A study from Johns Hopkins medicine16 found nearly 20 percent of adults prescribed antibiotics in the hospital experienced adverse side effects and nearly 20 percent of those side effects occurred in patients who didn't need the antibiotics in the first place. This report only adds to growing evidence antibiotic use is not benign.

Dr. Pranita Tamma, director of the pediatric antimicrobial stewardship program at The Johns Hopkins Hospital, commented on the results:17

"Too often, clinicians prescribe antibiotics even if they have a low suspicion for a bacterial infection, thinking that even if antibiotics may not be necessary, they are probably not harmful. But that is not always the case. Antibiotics have the potential to cause real harm to patients.

Each time we think to prescribe an antibiotic, we need to pause and ask ourselves, 'Does this patient really need an antibiotic?' If the patient develops an antibiotic-associated adverse reaction, even though that is, of course, unfortunate, we should be able to take some comfort in knowing that at least the antibiotic was truly necessary."

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